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Related Concept Videos

Spinal Nerves: Plexus II01:21

Spinal Nerves: Plexus II

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The plexuses of the lower body include the lumbar, sacral, and coccygeal plexuses, which innervate the abdomen, pelvis, legs, and coccygeal region. These plexuses control the transmission of sensory information and coordinate motor functions of the lower body.
The Lumbar Plexus
The lumbar plexus is situated within the lumbar region of the back and is primarily formed by the first four lumbar spinal nerves (L1 to L4). This plexus extends its branches into several nerves, including the...
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Sympathetic Pathways: Collateral Ganglia and Adrenal Medulla01:27

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The sympathetic pathways of the collateral ganglia and adrenal medulla serve unique but interconnected roles in the sympathetic response.
Collateral Ganglia
Sympathetic preganglionic axons reach the collateral ganglia along the route of splanchnic nerves. These nerves bypass the sympathetic trunk and communicate with sympathetic postganglionic neurons housed in the prevertebral ganglia. These ganglia supply the organs of the abdominopelvic cavity.
The greater splanchnic nerve, formed by the...
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Spinal Nerves: Plexus I01:22

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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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Somatic Spinal Reflexes01:22

Somatic Spinal Reflexes

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Somatic spinal reflexes are rapid, involuntary muscular responses to external stimuli that involve the somatic musculature and the spinal cord.
One of the most well-known somatic spinal reflexes is the stretch reflex, which is activated by the sudden stretching of a muscle. This reflex involves the activation of specialized sensory receptors called muscle spindles, which are located in the muscle tissue and detect changes in the length and speed of muscle contractions. When a muscle is suddenly...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Muscles that Move the Thigh01:20

Muscles that Move the Thigh

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The thigh's motion is primarily governed by muscles originating in the pelvic girdle and inserted into the femur. One crucial muscle, the iliopsoas, is a combination of the psoas major and the iliacus muscles, sharing a common insertion point on the lesser trochanter of the femur.
Three other significant muscles are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus maximus originates from the posterior surface of the ilium, sacrum, and coccyx, and the thoracolumbar...
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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
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Gluteal Contractions as a Gateway to Sacral Plexus.

Sandeep Diwan1, Abhijit Nair2, Bharati Adhye1

  • 1Anaesthesiology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, IND.

Cureus
|February 14, 2022
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Summary

Gluteal contractions are key indicators during neurostimulation-guided sacral plexus blocks (SPBs), guiding needle placement for effective anesthesia. This technique remains valuable when ultrasound is unavailable.

Keywords:
lumbar plexusnerve blockneurostimulationregional anesthesiasacral plexus

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Area of Science:

  • Anesthesiology
  • Neurology
  • Surgical Procedures

Background:

  • Neurostimulation-guided sacral plexus blocks (SPBs) are traditionally used for foot/ankle surgery and hip surgery adjuncts.
  • Ultrasound guidance is prevalent, but neurostimulation remains relevant in facilities lacking advanced equipment.
  • Understanding neurostimulation techniques for SPBs is crucial for anesthesiologists.

Purpose of the Study:

  • To investigate the practical application and key indicators of neurostimulation-guided SPB.
  • To describe the procedure in patients undergoing femoral fracture repair.

Main Methods:

  • A combined lumbar and sacral plexus block was performed on 10 patients (ASA physical status I-II) undergoing intramedullary femoral nailing.
  • Neurostimulation-guided SPB was administered following the lumbar plexus block.
  • Needle placement endpoint was determined by observing gluteal muscle contractions.

Main Results:

  • Gluteal contractions (dorsal or plantar flexion) were consistently observed during needle advancement in all patients.
  • The optimal endpoint for SPB was identified 1-1.5 mm past the point of gluteal contractions.
  • This finding highlights a reliable landmark for neurostimulation-guided SPB.

Conclusions:

  • Gluteal contractions serve as a critical, observable endpoint during neurostimulation-guided SPB.
  • This landmark facilitates accurate needle positioning for effective sacral plexus blockade.
  • Neurostimulation-guided SPB remains a viable technique, with gluteal contractions as a key procedural gateway.